| NPI | 1265794606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 265260) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA L-251887) |
| Enumeration Date | 2012-06-12 |
| Last Update Date | 2018-05-01 |