| NPI | 1700445533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME157125) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT217325) |
| Enumeration Date | 2019-06-05 |
| Last Update Date | 2022-06-17 |