| NPI | 1861184954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0116037612) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101285011) |
| Enumeration Date | 2023-05-25 |
| Last Update Date | 2025-02-28 |