| NPI | 1013935766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PR 16462) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME97798) |
| 208D00000X General Practice (Licence: PR 16462) | |
| 208D00000X General Practice (Licence: NY 240913) | |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2024-05-11 |