| NPI | 1700809555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX L4196) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX L4196) |
| 207R00000X Internal Medicine (Licence: KY 33820) | |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2017-01-13 |