| NPI | 1902034093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PR 018165) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 27,373-R) |
| Enumeration Date | 2009-06-26 |
| Last Update Date | 2025-04-01 |