| NPI | 1861649956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: DC MD042039) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VT 042-0011639) |
| Enumeration Date | 2008-08-20 |
| Last Update Date | 2021-11-05 |