| NPI | 1811948847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VT 0420011399) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 153606) |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2016-09-02 |