| NPI | 1700032471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 265917) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 49718) |
| Enumeration Date | 2008-08-14 |
| Last Update Date | 2022-03-31 |