| NPI | 1588340830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 90188) |
| Additional Taxonomies | 208D00000X General Practice (Licence: GA 109387) |
| Enumeration Date | 2023-06-22 |
| Last Update Date | 2025-12-18 |