| NPI | 1477857563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME112517) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 272241) |
| 208D00000X General Practice (Licence: NY 259771) | |
| Enumeration Date | 2011-01-04 |
| Last Update Date | 2019-01-24 |