| NPI | 1184037012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 272970) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 259402) |
| Enumeration Date | 2014-06-09 |
| Last Update Date | 2021-06-10 |