| NPI | 1851568950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX P1301) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME108498) |
| Enumeration Date | 2008-05-08 |
| Last Update Date | 2015-05-05 |