| NPI | 1447019591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ID MRO-2405) |
| Additional Taxonomies | 208D00000X General Practice (Licence: ID 4771899) |
| Enumeration Date | 2024-03-18 |
| Last Update Date | 2026-03-11 |