| NPI | 1679560551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX G8186) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: UT 4820779-1205) |
| Enumeration Date | 2005-10-05 |
| Last Update Date | 2012-02-17 |