| NPI | 1760575443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: DC MD20793) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101047443) |
| 207R00000X Internal Medicine (Licence: TX G6003) | |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2014-04-03 |