| NPI | 1700947744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD2010-0714) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VT 0420008626) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2024-05-23 |