| NPI | 1730504879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME172811) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101260378) |
| Enumeration Date | 2014-02-26 |
| Last Update Date | 2025-12-12 |