| NPI | 1912464827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NE 32738) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 1912464827) |
| Enumeration Date | 2019-02-27 |
| Last Update Date | 2025-09-23 |