| NPI | 1902364474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RA0201X Internal Medicine, Allergy & Immunology (Licence: VA 0102206297) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0102206297) |
| Enumeration Date | 2019-03-04 |
| Last Update Date | 2022-08-03 |