| NPI | 1720005556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VT 042-0008368) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME MD26932) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2025-05-22 |