| NPI | 1477189256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NE 34416) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 34416) |
| Enumeration Date | 2020-03-12 |
| Last Update Date | 2023-08-16 |