| NPI | 1780068809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME129357) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PR 31590R) |
| 207Q00000X Family Medicine (Licence: FL ME129357) | |
| Enumeration Date | 2015-07-18 |
| Last Update Date | 2025-01-10 |