| NPI | 1184734360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VT 042.0007993) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VT 0420007993) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2015-06-17 |