| NPI | 1144434010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: TX P2822) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT-183294) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2013-10-17 |