| NPI | 1124138961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX M0348) |
| Additional Taxonomies | 207RI0200X Internal Medicine, Infectious Disease (Licence: TX M0348) |
| 207RI0200X Internal Medicine, Infectious Disease (Licence: SD 9604) | |
| 207R00000X Internal Medicine (Licence: SD 9604) | |
| 207R00000X Internal Medicine (Licence: OK 28824) | |
| 207RI0200X Internal Medicine, Infectious Disease (Licence: OK 28824) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2015-10-28 |