| NPI | 1447498712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME109549) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10031136) |
| Enumeration Date | 2009-01-25 |
| Last Update Date | 2021-10-26 |