| NPI | 1285689620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME132006) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D33719) |
| 207R00000X Internal Medicine (Licence: MN 75982) | |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2025-05-07 |