| NPI | 1417454075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: AR E-14796) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A164760) |
| 208D00000X General Practice (Licence: CA A164760) | |
| Enumeration Date | 2018-04-10 |
| Last Update Date | 2024-09-03 |