| NPI | 1750958179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME163692) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TRN32800) |
| Enumeration Date | 2021-06-04 |
| Last Update Date | 2023-07-28 |