| NPI | 1760125793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME172232) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL 34659) |
| Enumeration Date | 2022-04-18 |
| Last Update Date | 2025-07-02 |