| NPI | 1962082560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 288913) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA TBD) |
| Enumeration Date | 2021-04-09 |
| Last Update Date | 2023-02-24 |