| NPI | 1003437898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VT 032-0134127) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 0000000000000) |
| Enumeration Date | 2020-05-03 |
| Last Update Date | 2024-03-05 |