| NPI | 1598744633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX h2800) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX H2800) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: TX H2800) | |
| Enumeration Date | 2006-01-16 |
| Last Update Date | 2009-02-26 |