| NPI | 1619430790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME151685) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME151685) |
| Enumeration Date | 2019-04-07 |
| Last Update Date | 2024-07-12 |