| NPI | 1720475122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: UT 12436083-1205) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX S4803) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX S4803) | |
| Enumeration Date | 2015-04-23 |
| Last Update Date | 2021-09-13 |