| NPI | 1003278573 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME166822) | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A172893) | 
| Enumeration Date | 2016-03-24 | 
| Last Update Date | 2025-06-02 |