Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | M4300 | TX |
N | 208D00000X | General Practice Physician | M4300 | TX |
NPI | 1043331903 |
---|---|
Provider Name | Michael Liu |
First Address | San Antonio, TX 78253-5666 |
Second Address | San Antonio, TX 78238-1985 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2007 |
Last Update Date | 05/06/2013 |