| NPI | 1629049895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME129056) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 36766) |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2023-07-07 |