| NPI | 1477852648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 53132) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA 14452) |
| Enumeration Date | 2011-03-27 |
| Last Update Date | 2016-05-04 |