| NPI | 1144640798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX V4223) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN 72770) |
| 207R00000X Internal Medicine (Licence: KY C3300) | |
| 207R00000X Internal Medicine (Licence: IL 036144046) | |
| 207R00000X Internal Medicine (Licence: MI EMC0005902) | |
| 207R00000X Internal Medicine (Licence: OH 35C.001973) | |
| 207R00000X Internal Medicine (Licence: IN 01095021A) | |
| 207R00000X Internal Medicine (Licence: PA MD487234C) | |
| Enumeration Date | 2014-04-22 |
| Last Update Date | 2025-10-01 |