| NPI | 1649269184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ME MD23696) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VT 0420009507) |
| Enumeration Date | 2005-10-18 |
| Last Update Date | 2020-09-30 |