| NPI | 1265933790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME171726) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101267942) |
| Enumeration Date | 2018-02-21 |
| Last Update Date | 2025-10-06 |