| NPI | 1255627618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 52527) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 37293) |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2024-07-18 |