| NPI | 1851434435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PR 14599) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX P7616) |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2019-09-10 |