| NPI | 1801183520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME157473) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 247838) |
| 207R00000X Internal Medicine (Licence: NY 288227-01) | |
| Enumeration Date | 2011-07-01 |
| Last Update Date | 2024-10-04 |