| NPI | 1346468246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX K3100) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: UT 263074-1205) |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2007-07-08 |