| NPI | 1679902241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME136637) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY P91085) |
| 208000000X Pediatrics (Licence: NY P91085) | |
| Enumeration Date | 2013-11-05 |
| Last Update Date | 2026-05-18 |