| NPI | 1144803453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: NC 2022-02192) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2022-02192) |
| Enumeration Date | 2021-05-04 |
| Last Update Date | 2022-09-12 |