| NPI | 1255326328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: FL ME68678) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME0068678) |
| 207R00000X Internal Medicine (Licence: TX T1890) | |
| Enumeration Date | 2005-09-15 |
| Last Update Date | 2025-05-01 |