| NPI | 1801032602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101235804) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX K3573) |
| Enumeration Date | 2008-12-29 |
| Last Update Date | 2008-12-29 |