| NPI | 1063589851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VT 0420006849) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 170291-1) |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2012-08-15 |