| NPI | 1588077309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME143034) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT207134) |
| Enumeration Date | 2014-06-09 |
| Last Update Date | 2020-02-24 |