| NPI | 1689202517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME166352) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 94964) |
| Enumeration Date | 2020-03-27 |
| Last Update Date | 2024-05-08 |