| NPI | 1588763403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 044730) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME97061) |
| 207R00000X Internal Medicine (Licence: MA 230338) | |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2022-06-09 |