| NPI | 1750556171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101239884) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101239884) |
| 208D00000X General Practice (Licence: VA 0101239884) | |
| Enumeration Date | 2008-04-26 |
| Last Update Date | 2020-12-01 |