| NPI | 1720039704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VT 032-0072647) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN DO000001622) |
| Enumeration Date | 2006-05-13 |
| Last Update Date | 2015-07-20 |