| NPI | 1467957993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME170741) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AL 42702) |
| Enumeration Date | 2018-03-27 |
| Last Update Date | 2026-02-05 |