| NPI | 1215598271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2022008396) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MO 2022008396) |
| Enumeration Date | 2019-06-20 |
| Last Update Date | 2024-04-12 |