| NPI | 1528010022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME60802) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME60802) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2023-03-07 |