| NPI | 1962432880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: VT 042.000528) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: VT 042-0005283) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2021-04-17 |