| NPI | 1447507330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX Q6904) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10044977) |
| 207R00000X Internal Medicine (Licence: PA MD455792) | |
| Enumeration Date | 2012-08-09 |
| Last Update Date | 2016-04-07 |