| NPI | 1235295643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME143385) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A120014) |
| 207R00000X Internal Medicine (Licence: NY 241637) | |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2022-05-26 |