| NPI | 1124256383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX R3543) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 27360) |
| 207R00000X Internal Medicine (Licence: IA 39195) | |
| 207R00000X Internal Medicine (Licence: IA R8670) | |
| Enumeration Date | 2009-06-26 |
| Last Update Date | 2018-08-13 |