| NPI | 1962676486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VT 042-0011799) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VT 042-0011799) |
| 207R00000X Internal Medicine (Licence: PA MT187591) | |
| Enumeration Date | 2008-04-16 |
| Last Update Date | 2020-09-17 |