| NPI | 1619288057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NH 18370) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 244859) |
| Enumeration Date | 2010-06-30 |
| Last Update Date | 2022-07-27 |