| NPI | 1174592638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME123151) |
| Additional Taxonomies | 208D00000X General Practice (Licence: HI 12707) |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2026-04-03 |