| NPI | 1174900526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME128363) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 18,952) |
| Enumeration Date | 2015-05-05 |
| Last Update Date | 2025-09-03 |