| NPI | 1770519977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 155654) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2019-00955) |
| 207R00000X Internal Medicine (Licence: SC 83125) | |
| 207R00000X Internal Medicine (Licence: TX S4251) | |
| 207R00000X Internal Medicine (Licence: AR E-12049) | |
| 207R00000X Internal Medicine (Licence: GA 82305) | |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2019-12-12 |