| NPI | 1770103186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: GA 98691) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| 207R00000X Internal Medicine (Licence: GA 98691) | |
| Enumeration Date | 2020-04-26 |
| Last Update Date | 2024-10-03 |