| NPI | 1154646560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX P6315) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: TX P6315) |
| 261QP2300X Clinic/Center, Primary Care (Licence: TX P6315) | |
| Enumeration Date | 2010-03-30 |
| Last Update Date | 2024-03-18 |