| NPI | 1952579443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME146232) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2010005845) |
| Enumeration Date | 2008-02-18 |
| Last Update Date | 2022-08-06 |