| NPI | 1073143780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: FL ME183580) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PR 21646) |
| Enumeration Date | 2020-01-22 |
| Last Update Date | 2026-07-31 |