| NPI | 1780683276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 235427) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101235912) |
| Enumeration Date | 2005-07-18 |
| Last Update Date | 2021-01-06 |