| NPI | 1285083568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 277654) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 267720) |
| Enumeration Date | 2016-06-08 |
| Last Update Date | 2021-08-12 |