| NPI | 1750489043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME166832) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX L0612) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2024-08-19 |