| NPI | 1861726481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 071065) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AL MD.32232) |
| Enumeration Date | 2009-09-29 |
| Last Update Date | 2022-11-29 |