| NPI | 1093274227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: FL ME146636) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TRN29081) |
| Enumeration Date | 2019-03-18 |
| Last Update Date | 2026-07-17 |