| NPI | 1952665036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A13698) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX Q2402) |
| 207R00000X Internal Medicine (Licence: FL TPOS216) | |
| Enumeration Date | 2012-07-03 |
| Last Update Date | 2023-06-05 |