| NPI | 1669617429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: UT 7147545-1205) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: UT 7147545-8905) |
| Enumeration Date | 2008-12-09 |
| Last Update Date | 2008-12-09 |