| NPI | 1801917372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 234624) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA L-224875) |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2009-12-09 |