| NPI | 1598111882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 349002) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL TPME6419) |
| 207Q00000X Family Medicine (Licence: PA MD4651167) | |
| 207Q00000X Family Medicine (Licence: VA 0101287907) | |
| 207Q00000X Family Medicine (Licence: MN 80895) | |
| Enumeration Date | 2016-05-05 |
| Last Update Date | 2026-03-04 |