| NPI | 1275572190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QU0200X Clinic/Center, Urgent Care (Licence: GA 043534) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 043534) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2020-07-06 |