| NPI | 1881079150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PR 19422) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 19422) |
| 282N00000X General Acute Care Hospital (Licence: PR 19422) | |
| Enumeration Date | 2015-07-28 |
| Last Update Date | 2025-09-22 |