| NPI | 1902160880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 260823) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 251805) |
| Enumeration Date | 2012-06-26 |
| Last Update Date | 2018-09-10 |