| NPI | 1598867012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX M3591) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MS 14038) |
| Enumeration Date | 2006-09-04 |
| Last Update Date | 2008-03-06 |