| NPI | 1982791984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME98758) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 227493) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2008-02-14 |