| NPI | 1962488056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QB0002X Family Medicine, Bariatric Medicine (Licence: VA 0101246943) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME85329) |
| Enumeration Date | 2005-12-20 |
| Last Update Date | 2021-06-11 |