| NPI | 1730454323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME112261) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 82536) |
| Enumeration Date | 2012-03-14 |
| Last Update Date | 2025-11-19 |