| NPI | 1821479007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 276898) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 263658) |
| Enumeration Date | 2015-06-14 |
| Last Update Date | 2018-09-04 |