| NPI | 1801412911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME160716) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2020013133) |
| 207R00000X Internal Medicine (Licence: KS 04-47700) | |
| 207R00000X Internal Medicine (Licence: MO 2021044514) | |
| Enumeration Date | 2020-06-24 |
| Last Update Date | 2024-04-12 |