| NPI | 1770725194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX P6723) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY 262133) |
| Enumeration Date | 2009-03-31 |
| Last Update Date | 2017-04-03 |