| NPI | 1447697743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AL MD.37491) |
| Additional Taxonomies | 208D00000X General Practice (Licence: IA MD44779) |
| 208D00000X General Practice (Licence: SC MD35678) | |
| Enumeration Date | 2013-05-28 |
| Last Update Date | 2021-06-14 |