| NPI | 1831273812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA G86565) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VT 042-0015837) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2022-05-12 |