| NPI | 1063152569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ID O-1933) |
| Additional Taxonomies | 208D00000X General Practice (Licence: ID O-1933) |
| Enumeration Date | 2022-03-31 |
| Last Update Date | 2026-02-14 |