| NPI | 1710583927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 75733) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 285490) |
| Enumeration Date | 2020-12-11 |
| Last Update Date | 2023-08-31 |