| NPI | 1205914884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 254843) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VT 042.0013274) |
| 207Q00000X Family Medicine (Licence: CA a88542) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2022-09-02 |