| NPI | 1023308210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX Q6137) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX Q6137) |
| Enumeration Date | 2011-04-09 |
| Last Update Date | 2024-09-12 |