| NPI | 1013079144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD12138) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL 823) |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2020-11-04 |