| NPI | 1952924334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: AL 43188) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4351046892) |
| Enumeration Date | 2020-05-20 |
| Last Update Date | 2021-10-29 |