| NPI | 1295041986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME142720) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A122899) |
| 207Q00000X Family Medicine (Licence: ID M12502) | |
| Enumeration Date | 2010-08-19 |
| Last Update Date | 2020-08-11 |