| NPI | 1699868174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME-149893) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 168113) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2024-11-04 |