| NPI | 1386663243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 33443) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 78790) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2019-08-13 |