| NPI | 1710482690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A164886) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A164886) |
| Enumeration Date | 2018-03-24 |
| Last Update Date | 2023-09-12 |