| NPI | 1679138424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME167330) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT222824) |
| Enumeration Date | 2019-05-07 |
| Last Update Date | 2024-12-27 |