| NPI | 1588860258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME0038819) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA G87098) |
| 207R00000X Internal Medicine (Licence: NY 229517-1) | |
| Enumeration Date | 2007-06-21 |
| Last Update Date | 2009-07-30 |