| NPI | 1710309661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301104304) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MI 4301104304) |
| Enumeration Date | 2014-01-13 |
| Last Update Date | 2021-05-24 |