| NPI | 1902843030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RA0000X Internal Medicine, Adolescent Medicine (Licence: TX L1567) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX L1567) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2014-06-24 |