| NPI | 1205968757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX N1889) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A96977) |
| Enumeration Date | 2007-03-11 |
| Last Update Date | 2020-10-26 |