| NPI | 1821258419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME115181) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 255868) |
| Enumeration Date | 2008-06-17 |
| Last Update Date | 2025-06-27 |