| 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 |