| NPI | 1932548880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME147536) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ R74064) |
| Enumeration Date | 2013-06-24 |
| Last Update Date | 2022-03-23 |