| NPI | 1386639516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VT 042.0015727) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA MD-48629) |
| Enumeration Date | 2005-09-14 |
| Last Update Date | 2022-03-01 |