| NPI | 1902093685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX M9108) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: TX M9108) |
| 207P00000X Emergency Medicine (Licence: TX M9108) | |
| Enumeration Date | 2007-09-26 |
| Last Update Date | 2020-06-17 |