| NPI | 1043802929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2022041862) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MO 2022041862) |
| Enumeration Date | 2021-02-11 |
| Last Update Date | 2025-07-03 |