| NPI | 1023303328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX Q4228) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX Q4228) |
| 207R00000X Internal Medicine (Licence: DC MD042805) | |
| Enumeration Date | 2011-06-14 |
| Last Update Date | 2021-05-18 |