| NPI | 1467451120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 154568) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VT 42-0007603) |
| 207Q00000X Family Medicine (Licence: FL ME80844) | |
| Enumeration Date | 2005-07-15 |
| Last Update Date | 2007-07-08 |