| NPI | 1235427451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME123816) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 281078-1) |
| Enumeration Date | 2011-07-21 |
| Last Update Date | 2021-04-06 |