| NPI | 1285809251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX p3733) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX FI3546883) |
| Enumeration Date | 2008-04-29 |
| Last Update Date | 2020-08-04 |