| NPI | 1508251596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301511906) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WI 68102-20) |
| Enumeration Date | 2015-04-06 |
| Last Update Date | 2024-07-03 |