NPI | 1093745580 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: VT 0420011847) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D0042816) |
Enumeration Date | 2006-07-03 |
Last Update Date | 2014-12-04 |