| NPI | 1114072782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME 78467) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA 153581) |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2025-03-10 |