| NPI | 1659703395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2016-01538) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2016-01538) |
| Enumeration Date | 2013-08-05 |
| Last Update Date | 2024-12-24 |