| NPI | 1982013710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME168136) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MS 25165) |
| Enumeration Date | 2014-08-06 |
| Last Update Date | 2024-05-15 |