| NPI | 1790742898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M-8822) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 291582) |
| 207Q00000X Family Medicine (Licence: ME MD18385) | |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2022-05-17 |