| NPI | 1881806982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 33896) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA G39470) |
| 207R00000X Internal Medicine (Licence: MN 25099) | |
| 207R00000X Internal Medicine (Licence: TX G0148) | |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2007-07-08 |