| NPI | 1598985657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD61420620) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VT 042-0011973) |
| Enumeration Date | 2007-04-30 |
| Last Update Date | 2023-08-15 |