| NPI | 1013276609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101254463) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME158195) |
| Enumeration Date | 2012-05-16 |
| Last Update Date | 2026-05-28 |