| NPI | 1558744128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX S9211) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AR E-11557) |
| 207R00000X Internal Medicine (Licence: OH 34.013971) | |
| 207R00000X Internal Medicine (Licence: VA 0116028050) | |
| Enumeration Date | 2015-07-01 |
| Last Update Date | 2023-08-25 |