| NPI | 1144602459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2024-01666) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 63823-20) |
| 207R00000X Internal Medicine (Licence: TN 59847) | |
| 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism (Licence: TX T1552) | |
| 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism (Licence: NC 2024-01666) | |
| Enumeration Date | 2015-06-23 |
| Last Update Date | 2024-08-14 |