| NPI | 1629043625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 54104) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 64560) |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2019-12-30 |