| NPI | 1316406812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PR 023706) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 36738) |
| Enumeration Date | 2019-03-14 |
| Last Update Date | 2024-03-26 |