| NPI | 1841231032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PR 11894) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ACN1378) |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2022-05-02 |