| NPI | 1851670483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME136961) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 275569) |
| 282N00000X General Acute Care Hospital | |
| Enumeration Date | 2011-08-13 |
| Last Update Date | 2020-02-24 |