| NPI | 1073990727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME163253) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 296053) |
| Enumeration Date | 2015-05-01 |
| Last Update Date | 2023-08-14 |