| NPI | 1790147940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME165844) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2019-01126) |
| Enumeration Date | 2016-03-27 |
| Last Update Date | 2024-04-12 |