| NPI | 1285743971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME163264) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 42508020) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2023-12-11 |