| NPI | 1043285141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME92706) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 207809) |
| 207RI0200X Internal Medicine, Infectious Disease (Licence: FL ME92706) | |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2021-12-14 |