| NPI | 1942610118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX R5359) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME133680) |
| 207R00000X Internal Medicine (Licence: CA 144042) | |
| Enumeration Date | 2014-04-28 |
| Last Update Date | 2023-08-07 |