| NPI | 1558639104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX Q1789) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital |
| Enumeration Date | 2011-12-11 |
| Last Update Date | 2020-09-08 |