| NPI | 1235108069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 278211) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101232383) |
| Enumeration Date | 2006-03-15 |
| Last Update Date | 2020-05-06 |