| NPI | 1588653521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 23553) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VT 042-0011937) |
| Enumeration Date | 2005-10-20 |
| Last Update Date | 2024-02-01 |