| NPI | 1891497731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2023021928) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MO 2025032966) |
| Enumeration Date | 2023-03-21 |
| Last Update Date | 2025-10-06 |