| NPI | 1811953839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AL MD.6825) |
| Additional Taxonomies | 208D00000X General Practice (Licence: AL 00006825) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2024-01-23 |