| NPI | 1841786670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME149794) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125071668) |
| Enumeration Date | 2018-07-04 |
| Last Update Date | 2021-05-05 |