| NPI | 1841387255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VT 042-0010375) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 224571101) |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2011-06-29 |