| NPI | 1760531461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME47178) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL 47178) |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2017-10-10 |