| NPI | 1861497372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D0061630) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME148198) |
| Enumeration Date | 2005-06-21 |
| Last Update Date | 2021-01-29 |