| NPI | 1174810048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX P7277) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 9407781) |
| Enumeration Date | 2011-06-29 |
| Last Update Date | 2014-07-08 |