| NPI | 1447678685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX R6889) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD460264) |
| Enumeration Date | 2014-04-04 |
| Last Update Date | 2019-05-26 |