| NPI | 1053385443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME134181) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 31406) |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2023-12-01 |