| NPI | 1609857663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 28604) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA G12228) |
| Enumeration Date | 2005-11-08 |
| Last Update Date | 2007-07-08 |