| NPI | 1417268251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX N6928) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10027911) |
| Enumeration Date | 2010-06-26 |
| Last Update Date | 2018-08-10 |