| NPI | 1578146965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 341516) |
| Additional Taxonomies | 208D00000X General Practice (Licence: OK 7741) |
| Enumeration Date | 2021-05-03 |
| Last Update Date | 2024-08-13 |