| NPI | 1629645171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME175452) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 12873) |
| Enumeration Date | 2021-06-04 |
| Last Update Date | 2025-07-23 |