| NPI | 1184818866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME104671) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 245909) |
| Enumeration Date | 2007-09-05 |
| Last Update Date | 2020-12-01 |