| NPI | 1629397344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 064499) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10027895) |
| Enumeration Date | 2010-05-20 |
| Last Update Date | 2010-06-09 |