| NPI | 1831321322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ME DO2256) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS12796) |
| Enumeration Date | 2009-08-17 |
| Last Update Date | 2019-05-12 |