| NPI | 1245904689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME165612) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT223924) |
| Enumeration Date | 2021-08-08 |
| Last Update Date | 2024-08-29 |