| NPI | 1699739078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME113276) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 236079) |
| Enumeration Date | 2006-04-13 |
| Last Update Date | 2020-01-22 |