| NPI | 1609162197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 53116) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 248448) |
| Enumeration Date | 2011-06-22 |
| Last Update Date | 2018-03-17 |