| NPI | 1033475603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101267406) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME124767) |
| Enumeration Date | 2012-04-08 |
| Last Update Date | 2025-07-23 |