| NPI | 1811577596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX V2151) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX V2151) |
| Enumeration Date | 2021-04-08 |
| Last Update Date | 2024-09-19 |