| NPI | 1205885480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME118494) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 222082) |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2021-01-29 |