| NPI | 1770103186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: GA 98691) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 98691) |
| Enumeration Date | 2020-04-26 |
| Last Update Date | 2024-02-28 |