| NPI | 1811342645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2020-03161) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME140754) |
| Enumeration Date | 2016-04-29 |
| Last Update Date | 2020-08-25 |