| NPI | 1477908903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: TX R9225) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX R9225) |
| 282NC0060X General Acute Care Hospital, Critical Access | |
| Enumeration Date | 2016-05-03 |
| Last Update Date | 2022-07-08 |