| NPI | 1295755288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60429813) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VT 0420009985) |
| 207Q00000X Family Medicine (Licence: NY 220232) | |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2014-01-15 |