| NPI | 1689637399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VT 042-0007191) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VT 0420007191) |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2022-06-01 |