| NPI | 1902898166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX K4026) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX K4026) |
| 207Q00000X Family Medicine (Licence: TX K4026) | |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2007-07-09 |