| NPI | 1720483431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME124804) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL trn17359) |
| Enumeration Date | 2014-10-24 |
| Last Update Date | 2025-09-03 |