| NPI | 1083982631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 282497) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 50605) |
| Enumeration Date | 2011-12-11 |
| Last Update Date | 2025-03-17 |