| NPI | 1669490926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A73310) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 220304) |
| 207R00000X Internal Medicine (Licence: GA 074485) | |
| 207R00000X Internal Medicine (Licence: MI 4301104580) | |
| 207R00000X Internal Medicine (Licence: NY 274755) | |
| 207R00000X Internal Medicine (Licence: OH 35.123940) | |
| 207R00000X Internal Medicine (Licence: PA MD451880) | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2016-05-22 |