| NPI | 1023228988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME 101162) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10021621) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2012-03-08 |