| NPI | 1225411440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NH 19452) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 264244) |
| Enumeration Date | 2015-07-07 |
| Last Update Date | 2021-08-10 |