| NPI | 1740787357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA T290380) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 311691) |
| Enumeration Date | 2018-04-10 |
| Last Update Date | 2021-09-27 |