| NPI | 1922154921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C137395) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 262000) |
| 207R00000X Internal Medicine (Licence: AZ 36399) | |
| 207R00000X Internal Medicine (Licence: MO 2012024217) | |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2023-03-16 |