| NPI | 1700063294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX N3941) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301088464) |
| Enumeration Date | 2008-01-28 |
| Last Update Date | 2012-11-28 |