| NPI | 1881787984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ME 013123) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VT 0420009395) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2011-04-12 |