| NPI | 1780979658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QB0002X Family Medicine, Bariatric Medicine (Licence: MD H0079510) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116023930) |
| Enumeration Date | 2011-06-17 |
| Last Update Date | 2023-05-16 |