| NPI | 1083225890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME176260) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY P105265) |
| Enumeration Date | 2020-08-14 |
| Last Update Date | 2026-07-24 |