| NPI | 1992986897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VT 042-0011885) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A96990) |
| Enumeration Date | 2007-11-19 |
| Last Update Date | 2020-09-17 |