| NPI | 1790947349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK 6427) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VT 042-0012050) |
| Enumeration Date | 2008-06-25 |
| Last Update Date | 2015-06-03 |