| NPI | 1376951046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 73153-20) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND RL14696) |
| 207R00000X Internal Medicine (Licence: AZ R74574) | |
| Enumeration Date | 2014-07-25 |
| Last Update Date | 2022-10-07 |