| NPI | 1265625289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 69293) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX M6181) |
| 207R00000X Internal Medicine (Licence: LA MD.201342) | |
| 207R00000X Internal Medicine (Licence: TN 42706) | |
| Enumeration Date | 2007-08-22 |
| Last Update Date | 2022-12-14 |