| NPI | 1841587839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VT 042.0012938) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME EC111064) |
| Enumeration Date | 2011-06-29 |
| Last Update Date | 2014-07-08 |