| NPI | 1285975250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301102779) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301102779) |
| Enumeration Date | 2013-03-15 |
| Last Update Date | 2025-03-03 |