| NPI | 1700050267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX Q0586) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN 46304) |
| Enumeration Date | 2008-04-16 |
| Last Update Date | 2014-10-07 |