| NPI | 1275782955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 21669) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA 86491) |
| 207R00000X Internal Medicine (Licence: HI 10015) | |
| 207R00000X Internal Medicine (Licence: LA 014476) | |
| Enumeration Date | 2008-09-17 |
| Last Update Date | 2023-09-27 |