| NPI | 1710070438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME109512) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A93829) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2023-04-12 |