| NPI | 1033520812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME131900) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 291178-1) |
| Enumeration Date | 2014-05-14 |
| Last Update Date | 2017-11-15 |