| NPI | 1710192737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 39848) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME0047331) |
| Enumeration Date | 2007-05-12 |
| Last Update Date | 2017-11-13 |