| NPI | 1073006375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WY 14038A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX S9053) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10062552) | |
| 207R00000X Internal Medicine (Licence: WY TL6832) | |
| Enumeration Date | 2018-06-11 |
| Last Update Date | 2021-11-01 |