| NPI | 1578021689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME171211) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL 1-012-002-0) |
| Enumeration Date | 2019-03-07 |
| Last Update Date | 2025-05-04 |