| NPI | 1669416202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VT 0420005392) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VT 042-0005392) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2013-12-09 |