| NPI | 1174325559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME172712) |
| Additional Taxonomies | 208D00000X General Practice (Licence: ZZ ME172712) |
| 207R00000X Internal Medicine (Licence: ZZ ME172712) | |
| Enumeration Date | 2025-03-26 |
| Last Update Date | 2025-10-15 |