| NPI | 1780927376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VT 042-0014024) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 266357) |
| Enumeration Date | 2013-04-02 |
| Last Update Date | 2021-08-03 |