| NPI | 1780023788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME129228) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125062509) |
| Enumeration Date | 2013-06-23 |
| Last Update Date | 2021-03-09 |