| NPI | 1477594752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NH 10169) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VT 420011112) |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2021-06-14 |