| NPI | 1396807251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2021-02818) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301099546) |
| 207R00000X Internal Medicine (Licence: VT 42-0010938) | |
| Enumeration Date | 2006-12-15 |
| Last Update Date | 2022-06-22 |