| NPI | 1760473656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NH 17238) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 150208) |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2015-09-08 |