| NPI | 1073850541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX D6360) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AR C-40007) |
| Enumeration Date | 2013-01-03 |
| Last Update Date | 2013-01-03 |