| NPI | 1073758967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX P1517) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10031157) |
| Enumeration Date | 2008-12-08 |
| Last Update Date | 2015-05-18 |