| NPI | 1003438870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME162789) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD479176) |
| Enumeration Date | 2020-05-14 |
| Last Update Date | 2023-06-28 |