| NPI | 1679536189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME0055652) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL 55652) |
| Enumeration Date | 2006-04-07 |
| Last Update Date | 2024-02-29 |