| NPI | 1801871116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 71520) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA MA71520) |
| Enumeration Date | 2005-12-08 |
| Last Update Date | 2020-03-30 |