| NPI | 1235572413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2014008957) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AL MD.39192) |
| 207R00000X Internal Medicine (Licence: KS 0419982) | |
| 207R00000X Internal Medicine (Licence: IL 036.144391) | |
| 207R00000X Internal Medicine (Licence: MI EMC0000088) | |
| 207R00000X Internal Medicine (Licence: TN 60621) | |
| 207R00000X Internal Medicine (Licence: WA 61025513) | |
| 207R00000X Internal Medicine (Licence: WI 623-320) | |
| Enumeration Date | 2013-04-08 |
| Last Update Date | 2020-02-14 |