| NPI | 1558775684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME140041) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT207386) |
| Enumeration Date | 2014-06-17 |
| Last Update Date | 2019-08-09 |