| NPI | 1497107759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME158865) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.068231) |
| Enumeration Date | 2016-07-11 |
| Last Update Date | 2025-11-25 |