| NPI | 1265069710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME174956) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.076413) |
| Enumeration Date | 2020-03-25 |
| Last Update Date | 2025-09-26 |