| NPI | 1518288604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX P5971) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CO DR.0072734) |
| Enumeration Date | 2010-06-12 |
| Last Update Date | 2024-06-19 |