| NPI | 1942212998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 279032) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 024379) |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2020-08-21 |