| NPI | 1922305440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME110561) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NV 14073) |
| 207R00000X Internal Medicine (Licence: NY 262773) | |
| Enumeration Date | 2011-02-18 |
| Last Update Date | 2023-09-14 |