| NPI | 1710976105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 6592) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VT 0420006919) |
| Enumeration Date | 2005-10-18 |
| Last Update Date | 2018-08-08 |