| NPI | 1881651560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 59349) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VT 42-0006983) |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2007-07-08 |