| NPI | 1972560696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 231683) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD H62994) |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2020-10-23 |