| NPI | 1932782307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PR 24882) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 24882) |
| Enumeration Date | 2021-05-03 |
| Last Update Date | 2026-04-21 |