| NPI | 1619528148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME157020) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT219587) |
| Enumeration Date | 2019-09-25 |
| Last Update Date | 2022-10-19 |