| NPI | 1417034943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME159614) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A75053) |
| 207R00000X Internal Medicine (Licence: NY 228064) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2023-01-04 |