| NPI | 1881159796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 32795) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 32795) |
| 207Q00000X Family Medicine (Licence: VT 042.0040412) | |
| Enumeration Date | 2019-02-05 |
| Last Update Date | 2026-06-18 |