| NPI | 1376580787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX N9639) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 239632) |
| 207R00000X Internal Medicine (Licence: PA MD428895) | |
| 207R00000X Internal Medicine (Licence: NY 239632) | |
| 207Q00000X Family Medicine (Licence: PA MD428895) | |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2016-03-04 |