| NPI | 1255771416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PR 19183) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 29353-R) |
| 208D00000X General Practice (Licence: PR 19183) | |
| Enumeration Date | 2013-07-02 |
| Last Update Date | 2021-06-24 |