| NPI | 1790289791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME148423) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX T4446) |
| Enumeration Date | 2018-03-23 |
| Last Update Date | 2022-11-11 |