| NPI | 1265958326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME148938) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY P06149) |
| Enumeration Date | 2017-08-20 |
| Last Update Date | 2021-07-20 |