| NPI | 1083685366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101057867) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101057867) |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2023-04-05 |