| NPI | 1346943297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 90359LL) |
| Additional Taxonomies | 208D00000X General Practice (Licence: GA 105705) |
| Enumeration Date | 2023-03-22 |
| Last Update Date | 2025-08-28 |