| NPI | 1437258829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME0044823) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME44823) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2024-06-04 |