| NPI | 1578883450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME116973) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX P7430) |
| 207Q00000X Family Medicine (Licence: TX P7430) | |
| Enumeration Date | 2010-06-02 |
| Last Update Date | 2024-10-21 |