| NPI | 1902877517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2021-03347) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN 46875) |
| 207RA0401X Internal Medicine, Addiction Medicine (Licence: NC 2021-03347) | |
| 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: TX L7208) | |
| 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: TN 46875) | |
| 208D00000X General Practice (Licence: NC 2021-03347) | |
| Enumeration Date | 2006-01-31 |
| Last Update Date | 2023-10-16 |