| NPI | 1063415727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME168899) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD489579) |
| 207R00000X Internal Medicine (Licence: PR 10725) | |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2025-10-16 |