| NPI | 1598755068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VT 0420010595) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM MD2019-0894) |
| Enumeration Date | 2005-10-26 |
| Last Update Date | 2023-06-29 |