| NPI | 1942275771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VT 042-0013372) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 200876) |
| Enumeration Date | 2006-02-23 |
| Last Update Date | 2016-02-25 |