| NPI | 1730679754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME148221) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TRN26739) |
| Enumeration Date | 2018-05-15 |
| Last Update Date | 2021-07-31 |