| NPI | 1639608300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME151109) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 311731) |
| Enumeration Date | 2017-06-07 |
| Last Update Date | 2023-11-14 |