| NPI | 1285012666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 54354) |
| Additional Taxonomies | 208D00000X General Practice (Licence: AZ 54354) |
| Enumeration Date | 2015-05-18 |
| Last Update Date | 2023-01-06 |