| NPI | 1871796961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 282838) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2010-00773) |
| Enumeration Date | 2007-06-07 |
| Last Update Date | 2020-06-02 |