| NPI | 1790858637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD486268) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VT 042-0010037) |
| 207Q00000X Family Medicine (Licence: FL ME76538) | |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2025-06-18 |