| NPI | 1316074776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO CDRH.0061297) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA L-228504) |
| 207R00000X Internal Medicine (Licence: AL 38056) | |
| 207R00000X Internal Medicine (Licence: NV 18759) | |
| 207R00000X Internal Medicine (Licence: TN 59425) | |
| 207R00000X Internal Medicine (Licence: UT 11224295-1205) | |
| 207R00000X Internal Medicine (Licence: CA C197633) | |
| 207R00000X Internal Medicine (Licence: IN 01094663A) | |
| 207R00000X Internal Medicine (Licence: GA 102003) | |
| 207R00000X Internal Medicine (Licence: MO 2024036775) | |
| 207R00000X Internal Medicine (Licence: NC 2024-02849) | |
| 207R00000X Internal Medicine (Licence: TX V5609) | |
| 261QM2500X Clinic/Center, Medical Specialty (Licence: NY 1043889967) | |
| 261QM2500X Clinic/Center, Medical Specialty (Licence: CT 1992372403) | |
| 261QM2500X Clinic/Center, Medical Specialty (Licence: NJ 1992372403) | |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2025-08-27 |