| NPI | 1720540644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX U8274) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA 191605) |
| 207R00000X Internal Medicine (Licence: NY 325123-01) | |
| 207R00000X Internal Medicine (Licence: IL 036.167798) | |
| 207R00000X Internal Medicine (Licence: FL ME153085) | |
| 207R00000X Internal Medicine (Licence: AZ 65920) | |
| Enumeration Date | 2019-04-01 |
| Last Update Date | 2024-10-21 |