| NPI | 1679603617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 274136) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI 12574) |
| 207R00000X Internal Medicine (Licence: ND ND 9484) | |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2018-05-07 |