| NPI | 1386934115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 262553) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD451511) |
| Enumeration Date | 2011-04-13 |
| Last Update Date | 2015-07-21 |