| NPI | 1225011208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VT 0320000562) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 02002376) |
| Enumeration Date | 2005-11-23 |
| Last Update Date | 2021-08-17 |