| NPI | 1083946693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX P2340) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA a111050) |
| Enumeration Date | 2010-02-06 |
| Last Update Date | 2013-12-06 |