| NPI | 1134757206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME155987) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A184065) |
| Enumeration Date | 2020-04-01 |
| Last Update Date | 2023-09-04 |