NPI | 1205862372 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 73831) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: VT 0320000406) |
Enumeration Date | 2006-06-23 |
Last Update Date | 2025-02-11 |