| NPI | 1518903293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ME MD23836) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 040809) |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2021-09-24 |