| NPI | 1073995049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME139688) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036.147247) |
| 207R00000X Internal Medicine (Licence: IL 125067856) | |
| Enumeration Date | 2015-06-25 |
| Last Update Date | 2021-01-25 |