| NPI | 1083659585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 216467) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NH 12465) |
| Enumeration Date | 2006-06-18 |
| Last Update Date | 2022-09-22 |