| NPI | 1225050776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 14290) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VT 042-0009431) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2023-11-15 |