| NPI | 1902807381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME119091) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301072089) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2025-07-21 |