| NPI | 1972034676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME146550) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 009146) |
| Enumeration Date | 2017-03-23 |
| Last Update Date | 2021-10-06 |