| NPI | 1992362487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME156317) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA MD-47682) |
| Enumeration Date | 2019-05-21 |
| Last Update Date | 2023-07-14 |