| NPI | 1659098481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL 41725) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL 41725) |
| 207Q00000X Family Medicine (Licence: FL 41725) | |
| 291U00000X Clinical Medical Laboratory (Licence: FL 41725) | |
| 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: FL 41725) | |
| Enumeration Date | 2022-10-24 |
| Last Update Date | 2022-10-24 |