| NPI | 1134380173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A120555) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 266249) |
| 207R00000X Internal Medicine (Licence: ME MD18844) | |
| Enumeration Date | 2008-06-23 |
| Last Update Date | 2022-06-10 |