| NPI | 1568618874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2008-01598) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: NC 2008-01598) |
| Enumeration Date | 2008-08-18 |
| Last Update Date | 2015-09-29 |