| NPI | 1508132762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME 60537) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC MD 30287) |
| 207Q00000X Family Medicine (Licence: MD D0069526) | |
| 207Q00000X Family Medicine (Licence: MS 20137) | |
| Enumeration Date | 2012-03-31 |
| Last Update Date | 2023-03-07 |