| NPI | 1932111614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX S1021) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301081721) |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2023-03-18 |