| NPI | 1720185630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: FL ME100463) |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: NY 237061) |
| 207P00000X Emergency Medicine (Licence: FL ME100463) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2014-11-04 |