| NPI | 1922535343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 334762) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME144037) |
| Enumeration Date | 2017-05-16 |
| Last Update Date | 2023-02-13 |