| NPI | 1548675697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 67864-20) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 67864-20) |
| 208000000X Pediatrics (Licence: WI 67864-20) | |
| Enumeration Date | 2014-06-27 |
| Last Update Date | 2022-05-24 |