| NPI | 1508273855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME146613) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 59546) |
| Enumeration Date | 2014-07-18 |
| Last Update Date | 2024-06-10 |