| NPI | 1194971028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME110427) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301092319) |
| Enumeration Date | 2008-08-12 |
| Last Update Date | 2024-01-29 |