| NPI | 1902468796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX T8807) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT219432) |
| Enumeration Date | 2019-07-02 |
| Last Update Date | 2022-08-11 |