| NPI | 1891363388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: MA 289493) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 289493) |
| Enumeration Date | 2021-06-11 |
| Last Update Date | 2023-07-13 |