| NPI | 1841243557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 290818) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME90446) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2026-05-19 |