| NPI | 1669547907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VT 042-0011217) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ME MD24957) |
| 207R00000X Internal Medicine (Licence: NH 18102) | |
| Enumeration Date | 2006-11-22 |
| Last Update Date | 2022-03-21 |