| NPI | 1255081147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL OS21902) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL OS21902) |
| Enumeration Date | 2022-03-24 |
| Last Update Date | 2026-07-15 |