| NPI | 1003376369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NH EL09308) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NM MD2021-0839) |
| Enumeration Date | 2019-03-22 |
| Last Update Date | 2022-09-09 |