| NPI | 1811964471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101258537) |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: MD D0106118) |
| 208D00000X General Practice (Licence: MS 19076) | |
| Enumeration Date | 2006-03-02 |
| Last Update Date | 2026-09-30 |