| NPI | 1114010881 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VT 042-0011579) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NH RT-1357) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2016-08-23 |