| NPI | 1952988958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A196480) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NM MD2023-1209) |
| Enumeration Date | 2021-03-25 |
| Last Update Date | 2025-10-20 |