| NPI | 1235214008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 210140) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD071530L) |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2022-10-19 |