| NPI | 1730165234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VT 042-0012245) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 159649) |
| Enumeration Date | 2005-12-16 |
| Last Update Date | 2020-06-23 |