| NPI | 1790989499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME171040) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2008-01432) |
| Enumeration Date | 2007-06-14 |
| Last Update Date | 2025-02-21 |