| NPI | 1194214874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME172508) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 31270101) |
| 207R00000X Internal Medicine (Licence: PA MD475502) | |
| Enumeration Date | 2018-05-08 |
| Last Update Date | 2025-08-29 |