| NPI | 1821549049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME170046) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 313186) |
| Enumeration Date | 2016-10-24 |
| Last Update Date | 2024-10-29 |