| NPI | 1679525596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 226223) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NH 12829) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2020-04-27 |