| NPI | 1871817189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX T9759) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A108784) |
| Enumeration Date | 2010-03-16 |
| Last Update Date | 2023-06-21 |