| NPI | 1659380202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME072025) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 2396581) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2019-09-05 |