| NPI | 1639467376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME149076) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 35497) |
| 2083B0002X Preventive Medicine, Obesity Medicine (Licence: SC 35497) | |
| Enumeration Date | 2011-07-15 |
| Last Update Date | 2024-04-15 |