| NPI | 1699158337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 275011) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 264350) |
| Enumeration Date | 2015-06-30 |
| Last Update Date | 2018-12-10 |