| NPI | 1972730653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 50979) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 240573) |
| Enumeration Date | 2009-06-19 |
| Last Update Date | 2022-07-29 |