| NPI | 1740666833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME159524) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD464308) |
| Enumeration Date | 2015-07-31 |
| Last Update Date | 2023-07-18 |