| NPI | 1881670677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX N2479) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036075840) |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2012-01-12 |