| NPI | 1043212780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME144859) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036-105927) |
| Enumeration Date | 2005-08-12 |
| Last Update Date | 2025-08-15 |