| NPI | 1790858637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VT 042-0010037) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME76538) |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2023-04-04 |