| NPI | 1508050048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME113603) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX N7236) |
| Enumeration Date | 2007-08-28 |
| Last Update Date | 2016-11-14 |