| NPI | 1790071926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: GA 0050803) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 005083) |
| Enumeration Date | 2011-06-27 |
| Last Update Date | 2019-10-21 |