| NPI | 1598765091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX K9971) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX K9971) |
| 208000000X Pediatrics (Licence: TX K9971) | |
| Enumeration Date | 2005-07-26 |
| Last Update Date | 2015-08-12 |