| NPI | 1417464041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PR 22342) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 22342) |
| Enumeration Date | 2018-01-04 |
| Last Update Date | 2023-06-21 |