| NPI | 1588640635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine (Licence: VT 042-0008256) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VT 0420008256) |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2016-08-22 |