| NPI | 1700171014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX Q0526) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX QO526) |
| Enumeration Date | 2011-06-15 |
| Last Update Date | 2024-06-19 |