| NPI | 1689932717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 202K00000X Phlebology (Licence: FL ME171834) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME171834) |
| 207R00000X Internal Medicine (Licence: FL ME171834) | |
| 207R00000X Internal Medicine (Licence: OH 35.141681) | |
| Enumeration Date | 2012-04-26 |
| Last Update Date | 2025-03-22 |