| NPI | 1740307396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 246527) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ME 017360) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2015-03-31 |