| NPI | 1528396132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 54983) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 292214-1) |
| 207R00000X Internal Medicine (Licence: FL ME124622) | |
| 207R00000X Internal Medicine (Licence: VA 0101246259) | |
| Enumeration Date | 2009-11-20 |
| Last Update Date | 2020-07-22 |