| NPI | 1669889291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX R5095) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10049385) |
| Enumeration Date | 2014-07-15 |
| Last Update Date | 2018-10-17 |