| NPI | 1023166840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT MED-PHYS-LIC-12540) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MT 12450) |
| 207R00000X Internal Medicine (Licence: MT 12450) | |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2026-03-18 |