| NPI | 1497752901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME135676) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 225593) |
| Enumeration Date | 2005-06-30 |
| Last Update Date | 2021-09-01 |