| NPI | 1255775003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME158092) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 284639) |
| 202D00000X Integrative Medicine (Licence: MA 280658) | |
| Enumeration Date | 2013-04-23 |
| Last Update Date | 2022-09-20 |