| NPI | 1720582505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PR 24515) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME149528) |
| Enumeration Date | 2018-03-19 |
| Last Update Date | 2026-01-19 |