| NPI | 1649864372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PR 15999-i) |
| Additional Taxonomies | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: GA 87932) |
| 208D00000X General Practice (Licence: GA 87932) | |
| 208D00000X General Practice (Licence: CA 87932) | |
| Enumeration Date | 2021-02-23 |
| Last Update Date | 2022-03-23 |