| NPI | 1528683000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: MO 2023004712) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2023004712) |
| Enumeration Date | 2020-06-10 |
| Last Update Date | 2024-04-25 |