| NPI | 1467019109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ACN1213) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 21223) |
| Enumeration Date | 2019-05-28 |
| Last Update Date | 2020-12-14 |