| NPI | 1578822748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 284728) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD172079) |
| 207Q00000X Family Medicine (Licence: VT 042.0014207) | |
| Enumeration Date | 2012-05-09 |
| Last Update Date | 2024-06-04 |