| NPI | 1508866922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME91443) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 232635) |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2022-08-12 |