| NPI | 1134862642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME175332) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4351049330) |
| Enumeration Date | 2022-04-14 |
| Last Update Date | 2025-07-01 |