| NPI | 1316981897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VT 042-0013453) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 224329) |
| 207Q00000X Family Medicine (Licence: PA MD461662) | |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2022-08-25 |