| NPI | 1841738291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PR 19545) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 19545) |
| Enumeration Date | 2017-02-06 |
| Last Update Date | 2023-10-05 |