| NPI | 1851699425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX E1341) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AR C4288) |
| Enumeration Date | 2011-03-07 |
| Last Update Date | 2011-07-01 |