| NPI | 1023539160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 65771) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WI 7462220) |
| Enumeration Date | 2017-06-28 |
| Last Update Date | 2022-09-19 |