| NPI | 1538798657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: FL ME175918) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME175918) |
| Enumeration Date | 2020-04-02 |
| Last Update Date | 2025-08-02 |