| NPI | 1194088161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 280096) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA MD.207898) |
| Enumeration Date | 2012-06-24 |
| Last Update Date | 2019-09-19 |