| NPI | 1720309545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD185542) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VT 042.0012722) |
| Enumeration Date | 2010-06-16 |
| Last Update Date | 2018-03-17 |