| NPI | 1699901355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD157059) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VT 042.0012391) |
| Enumeration Date | 2009-06-08 |
| Last Update Date | 2026-07-23 |