| NPI | 1053457937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD160278) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VT 0600003443) |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2012-11-07 |