| NPI | 1205458783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 82731) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VT 042.0017798) |
| Enumeration Date | 2020-05-07 |
| Last Update Date | 2025-08-11 |