| NPI | 1174100788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VT 42.0017803) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NH 32138) |
| Enumeration Date | 2021-03-28 |
| Last Update Date | 2024-06-24 |