| NPI | 1225529894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME148015) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 71981) |
| Enumeration Date | 2018-05-19 |
| Last Update Date | 2022-10-10 |