| NPI | 1639465057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX BP10040418) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NV 18290) |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2019-01-31 |