| NPI | 1801195003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301105894) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A138940) |
| 208D00000X General Practice (Licence: MI 4301105894) | |
| Enumeration Date | 2011-03-28 |
| Last Update Date | 2023-09-19 |