| NPI | 1427113729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2021015735) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 047900) |
| 207R00000X Internal Medicine (Licence: NH RT1630) | |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2021-07-21 |