| NPI | 1609431386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 292112) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME155436) |
| Enumeration Date | 2019-05-07 |
| Last Update Date | 2022-10-26 |