| NPI | 1417410887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 75662) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 291275) |
| Enumeration Date | 2019-04-11 |
| Last Update Date | 2024-01-18 |