| NPI | 1770815292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 54257) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ME MD17611) |
| Enumeration Date | 2010-02-09 |
| Last Update Date | 2018-10-19 |