| NPI | 1699425488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME165163) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TRN35266) |
| Enumeration Date | 2022-03-25 |
| Last Update Date | 2023-12-11 |