| NPI | 1245771815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME136173) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101264890) |
| 207R00000X Internal Medicine (Licence: PR 32950R) | |
| Enumeration Date | 2017-03-16 |
| Last Update Date | 2019-11-27 |