| NPI | 1346261591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX M1067) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 229117) |
| Enumeration Date | 2006-07-22 |
| Last Update Date | 2013-09-30 |