| NPI | 1427746809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 337450) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 337450) |
| Enumeration Date | 2023-04-25 |
| Last Update Date | 2026-06-30 |