| NPI | 1912439621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: AR E-12081) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2020010595) |
| 207R00000X Internal Medicine (Licence: AR E-12081) | |
| 207R00000X Internal Medicine (Licence: MO 2020010595) | |
| Enumeration Date | 2017-03-31 |
| Last Update Date | 2025-12-18 |