| NPI | 1356937676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 22638) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 15692-I) |
| Enumeration Date | 2020-12-21 |
| Last Update Date | 2024-09-06 |