| NPI | 1225331945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS7784) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL 7784) |
| Enumeration Date | 2010-12-20 |
| Last Update Date | 2023-01-18 |