| NPI | 1558758730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME140521) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AR E-11359) |
| 207R00000X Internal Medicine (Licence: LA 339319) | |
| Enumeration Date | 2015-04-24 |
| Last Update Date | 2023-11-16 |