| NPI | 1578759197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: FL ME101417) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME101417) |
| Enumeration Date | 2007-09-18 |
| Last Update Date | 2022-12-13 |