| NPI | 1952507170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 01074832A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D15904) |
| 207R00000X Internal Medicine (Licence: TX H3129) | |
| 207R00000X Internal Medicine (Licence: IL 036-059866) | |
| Enumeration Date | 2007-06-25 |
| Last Update Date | 2018-03-17 |