| NPI | 1700494028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: MA 617-355-6000) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT220357) |
| 207R00000X Internal Medicine (Licence: MA 1014742) | |
| Enumeration Date | 2020-07-22 |
| Last Update Date | 2023-10-16 |