| NPI | 1972948701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME139320) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 283553) |
| Enumeration Date | 2013-05-07 |
| Last Update Date | 2021-11-30 |