| NPI | 1669679007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME170988) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC TL30226) |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2025-11-07 |