| NPI | 1306109228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX P8546) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX P8546) |
| 207Q00000X Family Medicine (Licence: TN 53218) | |
| Enumeration Date | 2012-06-18 |
| Last Update Date | 2018-11-16 |