| NPI | 1972024222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME152877) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.069802) |
| Enumeration Date | 2017-06-27 |
| Last Update Date | 2022-07-15 |