| NPI | 1023464872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME141475) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 56931) |
| Enumeration Date | 2016-05-11 |
| Last Update Date | 2022-12-13 |