| NPI | 1407430556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME168914) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ R78552) |
| Enumeration Date | 2021-05-05 |
| Last Update Date | 2024-07-31 |