| NPI | 1568755221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL OS11834) |
| Additional Taxonomies | 202K00000X (Licence: FL OS11834) |
| 208D00000X General Practice (Licence: FL OS11834) | |
| Enumeration Date | 2011-05-26 |
| Last Update Date | 2025-01-15 |