| NPI | 1386103646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 291514) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 279355) |
| Enumeration Date | 2019-03-17 |
| Last Update Date | 2022-05-06 |