| NPI | 1649910654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A202356) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101280507) |
| 208D00000X General Practice (Licence: VA 0101280507) | |
| Enumeration Date | 2022-03-29 |
| Last Update Date | 2025-08-31 |