| NPI | 1043286594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VT 042.0011623) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301047460) |
| Enumeration Date | 2006-02-24 |
| Last Update Date | 2014-12-04 |