| NPI | 1508899915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH EL12775) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2022-011755) |
| 207Q00000X Family Medicine (Licence: VT 042-0009719) | |
| Enumeration Date | 2006-07-09 |
| Last Update Date | 2023-09-25 |