| NPI | 1063047660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0102207055) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0102207055) |
| Enumeration Date | 2020-03-04 |
| Last Update Date | 2023-08-04 |