| NPI | 1861560898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 03022) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VT 032-0000461) |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2009-12-11 |