| NPI | 1841566403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NV 16712) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 55368) |
| 207R00000X Internal Medicine (Licence: WY TL5454) | |
| 207R00000X Internal Medicine (Licence: NY 281360) | |
| Enumeration Date | 2012-03-28 |
| Last Update Date | 2019-01-24 |