| NPI | 1629236252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D0068012) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: MD D0068012) |
| Enumeration Date | 2008-05-30 |
| Last Update Date | 2021-01-08 |