| NPI | 1790314060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL TRN39303) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2020002029) |
| Enumeration Date | 2020-04-07 |
| Last Update Date | 2024-10-01 |