| NPI | 1790551976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PR 024377) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 024377) |
| Enumeration Date | 2023-11-29 |
| Last Update Date | 2025-06-25 |