| NPI | 1144607193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME146971) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PR 21029) |
| Enumeration Date | 2015-04-29 |
| Last Update Date | 2024-06-14 |