| NPI | 1750762944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 274622) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 263040) |
| Enumeration Date | 2015-06-12 |
| Last Update Date | 2020-06-27 |