| NPI | 1063038487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 284953) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA ETLL-761) |
| Enumeration Date | 2020-06-22 |
| Last Update Date | 2020-07-06 |