| NPI | 1790863587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME139149) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 217522) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2021-09-13 |