| NPI | 1659682854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME148937) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A143986) |
| 207Q00000X Family Medicine (Licence: AK 142113) | |
| Enumeration Date | 2010-06-23 |
| Last Update Date | 2021-08-05 |