| NPI | 1235517194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX R4326) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10054292) |
| Enumeration Date | 2015-05-12 |
| Last Update Date | 2020-10-28 |