| NPI | 1891091484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME113693) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 265676) |
| Enumeration Date | 2011-01-31 |
| Last Update Date | 2021-06-17 |