| NPI | 1609029420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 15514) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NH 15514) |
| 207P00000X Emergency Medicine (Licence: CT 042414) | |
| 207P00000X Emergency Medicine (Licence: VT 042.0012952) | |
| 207Q00000X Family Medicine (Licence: CT 042414) | |
| 207Q00000X Family Medicine (Licence: NJ 25MA07905200) | |
| Enumeration Date | 2008-10-23 |
| Last Update Date | 2025-01-05 |