| NPI | 1053334219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: VA 0101257630) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101257630) |
| 207RA0401X Internal Medicine, Addiction Medicine (Licence: VA 0101257630) | |
| 208D00000X General Practice (Licence: TN 51691) | |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2026-02-25 |