| NPI | 1790043040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A155675) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 53782) |
| Enumeration Date | 2012-04-24 |
| Last Update Date | 2023-04-03 |