| NPI | 1154364974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX J91000) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX J91000) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2008-03-05 |