| NPI | 1851338032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX N5914) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME91251) |
| 207R00000X Internal Medicine (Licence: WA MD00047521) | |
| 207R00000X Internal Medicine (Licence: FL ME 91251) | |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2020-06-08 |