| NPI | 1821474099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME150915) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 080634) |
| Enumeration Date | 2015-08-10 |
| Last Update Date | 2023-01-27 |