| NPI | 1982648101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME74583) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME0074583) |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2025-12-08 |