| NPI | 1174589204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 10758) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 0502521) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2022-02-02 |