| NPI | 1821471210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 279752) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 264259) |
| Enumeration Date | 2015-07-02 |
| Last Update Date | 2019-11-06 |