| NPI | 1275707697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: VT 0420011991) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA mt189753) |
| Enumeration Date | 2008-04-16 |
| Last Update Date | 2013-07-03 |