| NPI | 1902269780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VT 032.0133987) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 298637) |
| 207R00000X Internal Medicine (Licence: CT 64961) | |
| Enumeration Date | 2016-03-30 |
| Last Update Date | 2022-08-05 |