| NPI | 1306894118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX H4439) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CO 38632) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2013-01-10 |