| NPI | 1033253554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX R1574) |
| Additional Taxonomies | 281P00000X Chronic Disease Hospital (Licence: VA 0101240965) |
| Enumeration Date | 2007-02-17 |
| Last Update Date | 2017-03-15 |