| NPI | 1891116471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME131392) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 19338) |
| Enumeration Date | 2013-12-26 |
| Last Update Date | 2022-02-09 |