| NPI | 1629181177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME121598) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 1659761) |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2023-08-16 |