| NPI | 1891948196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX P4285) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX TMB PIT # BP10031324) |
| Enumeration Date | 2008-10-30 |
| Last Update Date | 2014-10-07 |