| NPI | 1720607948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME151715) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TRN30877) |
| Enumeration Date | 2020-04-09 |
| Last Update Date | 2021-07-07 |