| NPI | 1811498082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME148277) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT214774) |
| Enumeration Date | 2018-02-23 |
| Last Update Date | 2021-11-22 |