| NPI | 1649455254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME111897) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 002995) |
| Enumeration Date | 2008-01-02 |
| Last Update Date | 2023-01-25 |