| NPI | 1699351536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 350897) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NC 2022-02807) |
| 208600000X Surgery (Licence: NC DUGA-WZT0L0) | |
| Enumeration Date | 2021-03-22 |
| Last Update Date | 2026-06-03 |