| NPI | 1710546528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IA DO-06107) |
| Additional Taxonomies | 208D00000X General Practice (Licence: IA DO-06107) |
| Enumeration Date | 2019-06-06 |
| Last Update Date | 2022-07-13 |