| NPI | 1730362567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: TX P6557) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX P6557) |
| Enumeration Date | 2007-12-15 |
| Last Update Date | 2019-02-01 |