| NPI | 1134583180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME138811) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2019-01770) |
| Enumeration Date | 2016-04-06 |
| Last Update Date | 2022-02-11 |