| NPI | 1649808452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME159361) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: UT 13059752-1205) |
| Enumeration Date | 2020-03-28 |
| Last Update Date | 2024-01-26 |