| NPI | 1659893857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 17782) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA DN015571) |
| Enumeration Date | 2017-07-10 |
| Last Update Date | 2025-06-24 |