| NPI | 1912163924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX F6543) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD038208E) |
| 207R00000X Internal Medicine (Licence: CA G43173) | |
| Enumeration Date | 2008-07-30 |
| Last Update Date | 2014-09-24 |