| NPI | 1003838210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 6756) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VT 6958) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2008-07-11 |