| NPI | 1720045529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 202596) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME88429) |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2009-02-12 |