| NPI | 1811938491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: DE C1-0008006) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VT 42011038) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2013-02-20 |