| NPI | 1588979884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NM MD2013-0563) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD449260) |
| 207R00000X Internal Medicine (Licence: MN 56794) | |
| 207R00000X Internal Medicine (Licence: ND 12986) | |
| 207R00000X Internal Medicine (Licence: MA 256979) | |
| 207R00000X Internal Medicine (Licence: VA 101255547) | |
| 207R00000X Internal Medicine (Licence: MD D0077556) | |
| Enumeration Date | 2010-08-11 |
| Last Update Date | 2014-10-17 |