| NPI | 1003974452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME 103572) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 213873) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2011-06-07 |