| NPI | 1184658759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PR 13,130) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME131184) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2022-10-18 |