| NPI | 1326382169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME132094) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 281102) |
| Enumeration Date | 2012-11-17 |
| Last Update Date | 2018-09-06 |