| NPI | 1063107944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX BP10083898) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX W0615) |
| Enumeration Date | 2023-04-07 |
| Last Update Date | 2025-10-20 |