| NPI | 1841462892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME134423) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101245943) |
| Enumeration Date | 2008-03-31 |
| Last Update Date | 2022-11-25 |