| NPI | 1366607798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME176308) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2011022967) |
| 207R00000X Internal Medicine (Licence: KS 04-36914) | |
| Enumeration Date | 2008-07-24 |
| Last Update Date | 2025-09-17 |