| NPI | 1639855570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: MI 4301514046) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4351051920) |
| Enumeration Date | 2023-06-26 |
| Last Update Date | 2025-06-09 |