| NPI | 1013237536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VT 042.0018833) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2012-00969) |
| Enumeration Date | 2010-06-07 |
| Last Update Date | 2025-10-23 |