| NPI | 1134706781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME160880) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME160880) |
| Enumeration Date | 2021-03-28 |
| Last Update Date | 2024-09-17 |