| NPI | 1710929930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME59408) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME059408) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2018-10-12 |