| NPI | 1760971816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME152257) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: UT 11420203-1205) |
| Enumeration Date | 2018-05-04 |
| Last Update Date | 2026-02-10 |