| NPI | 1467911222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 5101025803) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MI 5101025803) |
| Enumeration Date | 2019-03-19 |
| Last Update Date | 2025-05-29 |