| NPI | 1699919571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME124531) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 260087) |
| Enumeration Date | 2009-04-23 |
| Last Update Date | 2017-01-06 |