| NPI | 1912167818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C208820) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036.125611) |
| 208D00000X General Practice (Licence: IL 036.125611) | |
| Enumeration Date | 2008-06-13 |
| Last Update Date | 2026-08-11 |