| NPI | 1083716047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX K7718) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MA07645300) |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2007-07-08 |