| NPI | 1790279842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: MO 2021013944) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2021013944) |
| Enumeration Date | 2018-06-20 |
| Last Update Date | 2021-11-15 |