| NPI | 1497909345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME157718) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 273301) |
| Enumeration Date | 2008-11-05 |
| Last Update Date | 2024-05-16 |