| NPI | 1285976027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME139472) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 285592) |
| 207R00000X Internal Medicine (Licence: TX R2452) | |
| Enumeration Date | 2013-03-19 |
| Last Update Date | 2022-07-21 |