| NPI | 1497168983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA MD286527) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PA MD461326) |
| Enumeration Date | 2014-06-03 |
| Last Update Date | 2024-06-06 |