| NPI | 1275774598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME119776) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NM MD2024-0229) |
| Enumeration Date | 2009-03-17 |
| Last Update Date | 2024-04-11 |