| NPI | 1558689349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 278779) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NH 16216) |
| Enumeration Date | 2010-05-04 |
| Last Update Date | 2024-01-30 |