| NPI | 1124023510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 16343) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 33319) |
| 208D00000X General Practice (Licence: NC 33319) | |
| Enumeration Date | 2005-06-14 |
| Last Update Date | 2026-06-03 |