| NPI | 1639524556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME163294) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NV 19257) |
| Enumeration Date | 2016-04-28 |
| Last Update Date | 2023-10-12 |