| NPI | 1891226155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME151758) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: DC MTL004112) |
| Enumeration Date | 2017-03-27 |
| Last Update Date | 2026-04-16 |