| NPI | 1033195359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME131542) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 162446) |
| Enumeration Date | 2005-12-19 |
| Last Update Date | 2024-03-13 |