| NPI | 1558659367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 275563) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VT 042-0015443) |
| Enumeration Date | 2011-07-13 |
| Last Update Date | 2021-12-17 |