| NPI | 1477567543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 49326) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VT 042-0010925) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2011-04-06 |