| NPI | 1194358952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101273284) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101273284) |
| Enumeration Date | 2020-02-19 |
| Last Update Date | 2024-11-21 |