| NPI | 1952991820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301512839) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL 168248) |
| Enumeration Date | 2021-01-24 |
| Last Update Date | 2025-07-29 |