| NPI | 1376122895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME167235) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2022-02443) |
| Enumeration Date | 2021-04-02 |
| Last Update Date | 2024-07-02 |