| NPI | 1497098610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 295461) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2019-00008) |
| 207Q00000X Family Medicine (Licence: FL OS19085) | |
| 207Q00000X Family Medicine (Licence: IL 036161281) | |
| 207Q00000X Family Medicine (Licence: TN 3135) | |
| Enumeration Date | 2013-04-05 |
| Last Update Date | 2023-03-17 |