| NPI | 1962066613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME155908) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME155908) |
| Enumeration Date | 2019-04-29 |
| Last Update Date | 2025-12-11 |