| NPI | 1629496336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX K4238) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX K4238) |
| 208000000X Pediatrics (Licence: TX K4238) | |
| Enumeration Date | 2014-03-31 |
| Last Update Date | 2021-01-25 |