| NPI | 1891704581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME115560) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101239927) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2024-05-29 |