| NPI | 1366914111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 21181) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI LP04752) |
| Enumeration Date | 2018-12-18 |
| Last Update Date | 2021-04-13 |