| NPI | 1811282098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX P6270) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10041535) |
| Enumeration Date | 2011-06-15 |
| Last Update Date | 2015-03-18 |