| NPI | 1144480138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 250364) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NH 15576) |
| Enumeration Date | 2008-06-12 |
| Last Update Date | 2021-07-27 |