| NPI | 1548234040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 9422) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VT 0420009104) |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2011-09-27 |