| NPI | 1730554007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 81656) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0102204947) |
| Enumeration Date | 2015-12-11 |
| Last Update Date | 2024-04-14 |