| NPI | 1922635044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 337951) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME158382) |
| Enumeration Date | 2020-03-26 |
| Last Update Date | 2023-08-24 |