| NPI | 1730475955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX R0424) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA 13366) |
| Enumeration Date | 2011-06-27 |
| Last Update Date | 2017-01-24 |