| NPI | 1548357312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism (Licence: TX J3404) |
| Additional Taxonomies | 305R00000X Preferred Provider Organization (Licence: TX J3404) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2013-12-11 |