| NPI | 1043280910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX M3571) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101102749) |
| Enumeration Date | 2006-01-24 |
| Last Update Date | 2007-07-08 |