| NPI | 1386830354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME155378) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX N1458) |
| Enumeration Date | 2007-09-24 |
| Last Update Date | 2023-02-28 |