| NPI | 1821009911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: SC 91017) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 241259-1) |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2026-01-08 |