| NPI | 1396572418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 125.086119) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WA 61594641) |
| Enumeration Date | 2024-09-14 |
| Last Update Date | 2025-06-03 |