| NPI | 1457371627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME115763) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX M4793) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2023-08-03 |