| NPI | 1093975278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX N4184) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT 188869) |
| Enumeration Date | 2008-06-11 |
| Last Update Date | 2013-01-11 |