| NPI | 1407236185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ME do2785) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL UO 4638) |
| Enumeration Date | 2015-06-08 |
| Last Update Date | 2021-01-20 |