| NPI | 1114505781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A197658) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A197658) |
| 208D00000X General Practice (Licence: CT 76080) | |
| 207R00000X Internal Medicine (Licence: CT 76080) | |
| Enumeration Date | 2021-04-01 |
| Last Update Date | 2026-06-30 |