| NPI | 1114989159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: NH 14132) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VT 042-0011120) |
| 2083A0300X Preventive Medicine, Addiction Medicine (Licence: NH 14132) | |
| Enumeration Date | 2006-04-05 |
| Last Update Date | 2023-02-15 |