| NPI | 1215441225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME151731) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 311194) |
| Enumeration Date | 2017-11-29 |
| Last Update Date | 2022-01-26 |