| NPI | 1083603922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 43264) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 43264) |
| Enumeration Date | 2005-10-13 |
| Last Update Date | 2026-02-24 |