| NPI | 1679528723 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VT 420007871) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NH 9110) |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2024-12-02 |