| NPI | 1013536549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 95668) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 95668) |
| Enumeration Date | 2020-04-14 |
| Last Update Date | 2025-09-16 |