| NPI | 1417382821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301059422) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MO 2007001489) |
| Enumeration Date | 2013-09-05 |
| Last Update Date | 2023-10-17 |