| NPI | 1174767867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A104175) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 257925) |
| 207R00000X Internal Medicine (Licence: FL ME158229) | |
| Enumeration Date | 2009-04-24 |
| Last Update Date | 2025-12-01 |