| NPI | 1194916320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 42494) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX J6339) |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2007-08-05 |