| NPI | 1922528215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 283985) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 272543) |
| Enumeration Date | 2017-06-27 |
| Last Update Date | 2020-06-20 |