| NPI | 1730127713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: GA 058939) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 058939) |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2022-08-18 |