| NPI | 1275655649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL MD.29274) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME103784) |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2023-05-26 |