| NPI | 1508949553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine Geriatric Medicine (Licence: VT 0420004984) |
| Additional Taxonomies | 207RG0300X Internal Medicine Geriatric Medicine (Licence: NH 5077) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2007-07-16 |