| NPI | 1093073280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TN md0000051052) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN 51052) |
| Enumeration Date | 2012-04-25 |
| Last Update Date | 2022-07-13 |