| NPI | 1245611532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 274258) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 263610) |
| Enumeration Date | 2015-06-12 |
| Last Update Date | 2019-10-03 |