| NPI | 1982638102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WY 7929A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VT 0420010989) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2022-02-23 |