| NPI | 1881041689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 01090812A) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX S2839) |
| Enumeration Date | 2016-05-21 |
| Last Update Date | 2023-07-13 |