| NPI | 1679571319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX F9887) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA CA40591) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2014-06-03 |