| NPI | 1245289552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME165330) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 162591) |
| 207R00000X Internal Medicine (Licence: PA MD 039602L) | |
| Enumeration Date | 2006-05-06 |
| Last Update Date | 2023-10-16 |