| NPI | 1255950713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME167093) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OK 35968) |
| Enumeration Date | 2020-04-14 |
| Last Update Date | 2024-07-22 |