| NPI | 1417368325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 1014705) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 56731) |
| Enumeration Date | 2014-05-13 |
| Last Update Date | 2023-05-10 |