| NPI | 1508245432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 273100) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA L-262951) |
| Enumeration Date | 2015-05-26 |
| Last Update Date | 2021-02-10 |