| NPI | 1356338107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: MO 2021048490) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2021048490) |
| 207R00000X Internal Medicine (Licence: MO 2021048490) | |
| Enumeration Date | 2005-10-05 |
| Last Update Date | 2024-04-25 |