| NPI | 1528113172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX Q3145) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2002031946) |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2020-04-17 |