| NPI | 1407240120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 273610) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 208206) |
| Enumeration Date | 2015-03-19 |
| Last Update Date | 2018-06-20 |