| NPI | 1578661187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: TX K3803) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX k3803) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2017-11-01 |