| NPI | 1558332916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 83822) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VT 0420010257) |
| Enumeration Date | 2006-02-01 |
| Last Update Date | 2020-12-07 |