| NPI | 1932201415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX L3592) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A73154) |
| Enumeration Date | 2006-09-03 |
| Last Update Date | 2015-07-02 |