| NPI | 1093017790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2011-01620) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WY 9949A) |
| 207R00000X Internal Medicine (Licence: UT 13239486-1205) | |
| Enumeration Date | 2010-12-01 |
| Last Update Date | 2023-03-29 |