| NPI | 1669449807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME91241) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 142773) |
| Enumeration Date | 2006-03-07 |
| Last Update Date | 2026-08-26 |