| NPI | 1720349137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME142823) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 207Q00000X Family Medicine (Licence: DE FJ4414025) | |
| 207QB0002X Family Medicine, Bariatric Medicine (Licence: FL ME142823) | |
| 207QB0002X Family Medicine, Bariatric Medicine (Licence: DE FJ4414025) | |
| Enumeration Date | 2012-06-01 |
| Last Update Date | 2024-06-06 |