| NPI | 1477080414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME154447) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY P04982) |
| Enumeration Date | 2017-05-22 |
| Last Update Date | 2022-01-19 |