| NPI | 1811964836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: AZ 2471) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VT 0320000477) |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2016-08-24 |