| NPI | 1568088151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 284819) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA ETLL-739) |
| Enumeration Date | 2020-06-19 |
| Last Update Date | 2020-06-26 |