| NPI | 1689361586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME170718) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TRN38093) |
| Enumeration Date | 2023-04-20 |
| Last Update Date | 2025-03-24 |