| NPI | 1144510074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX P3567) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD 60198526) |
| Enumeration Date | 2011-04-12 |
| Last Update Date | 2012-07-27 |