| NPI | 1891290136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME161045) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2021-01186) |
| Enumeration Date | 2018-03-28 |
| Last Update Date | 2024-07-05 |