| NPI | 1912432063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 009198) |
| Additional Taxonomies | 208600000X Surgery (Licence: OR PG182851) |
| 208D00000X General Practice (Licence: OR DO188985) | |
| Enumeration Date | 2017-04-26 |
| Last Update Date | 2022-01-03 |