| NPI | 1881784643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX K9021) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX K9021) |
| 208000000X Pediatrics (Licence: TX K9021) | |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2019-06-26 |