| NPI | 1639630098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: IA DO-05987) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA R-11707) |
| Enumeration Date | 2019-03-28 |
| Last Update Date | 2022-07-14 |