| NPI | 1639810211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX v3691) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NM DO2025-0185) |
| Enumeration Date | 2022-04-06 |
| Last Update Date | 2025-12-03 |