| NPI | 1578055877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME174461) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV 30870) |
| Enumeration Date | 2018-06-01 |
| Last Update Date | 2025-07-03 |