| NPI | 1023578473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME160464) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TRN0028144) |
| Enumeration Date | 2019-03-21 |
| Last Update Date | 2023-02-13 |