| NPI | 1245266782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 067390) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 23298) |
| 208D00000X General Practice (Licence: SC 23298) | |
| Enumeration Date | 2006-06-25 |
| Last Update Date | 2022-03-15 |