| NPI | 1871055418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME154818) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 317848) |
| Enumeration Date | 2019-04-02 |
| Last Update Date | 2024-07-25 |