| NPI | 1417377730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A150802) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10049465) |
| 207R00000X Internal Medicine (Licence: VA 0101263692) | |
| 207R00000X Internal Medicine (Licence: NY 294140) | |
| Enumeration Date | 2014-04-25 |
| Last Update Date | 2023-05-19 |