| NPI | 1780997106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME104585) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 003499) |
| Enumeration Date | 2010-07-15 |
| Last Update Date | 2020-07-08 |