| NPI | 1407018450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 252250) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD434840) |
| Enumeration Date | 2008-07-01 |
| Last Update Date | 2020-11-03 |