| NPI | 1861623431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 052284) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 241713) |
| Enumeration Date | 2009-07-30 |
| Last Update Date | 2013-08-05 |