| NPI | 1386957587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME163498) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 266766) |
| Enumeration Date | 2010-07-16 |
| Last Update Date | 2025-09-15 |