| NPI | 1336589167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 292717) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.063637) |
| Enumeration Date | 2013-06-25 |
| Last Update Date | 2022-08-22 |