| NPI | 1558473074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL 24918) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VT 0420010774) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2013-09-03 |