| NPI | 1629417969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 271661) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 255313) |
| Enumeration Date | 2013-06-20 |
| Last Update Date | 2017-10-18 |