| NPI | 1295096360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME160160) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA 338614) |
| 207R00000X Internal Medicine (Licence: VA 0101288101) | |
| 207R00000X Internal Medicine (Licence: PA MD491634C) | |
| 207Q00000X Family Medicine (Licence: FL ME160160) | |
| Enumeration Date | 2012-06-05 |
| Last Update Date | 2026-04-06 |