| NPI | 1144299124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RI0200X Internal Medicine, Infectious Disease (Licence: FL PA9105286) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL PA9105286) |
| 261QC1500X Clinic/Center, Community Health (Licence: FL PA9105286) | |
| 261QP2300X Clinic/Center, Primary Care (Licence: FL PA9105286) | |
| 363A00000X Physician Assistant (Licence: TX PA02326) | |
| 363AM0700X Physician Assistant, Medical (Licence: FL PA9105286) | |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2022-11-17 |