| NPI | 1841712106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX U2662) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AR E-13568) |
| Enumeration Date | 2017-07-07 |
| Last Update Date | 2023-08-14 |