| NPI | 1669102356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2022021592) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME175945) |
| Enumeration Date | 2022-06-15 |
| Last Update Date | 2025-09-09 |