| NPI | 1710960935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 28405) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CT 028405) |
| Enumeration Date | 2005-11-22 |
| Last Update Date | 2022-01-23 |