| NPI | 1427449776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NE 29731) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 29731) |
| Enumeration Date | 2015-02-09 |
| Last Update Date | 2024-03-07 |