| NPI | 1821223595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME114272) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL 31516) |
| 207Q00000X Family Medicine (Licence: MS 25695) | |
| Enumeration Date | 2009-05-23 |
| Last Update Date | 2022-11-30 |