| NPI | 1073259321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0116037252) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME177941) |
| 207Q00000X Family Medicine (Licence: MD D0105068) | |
| Enumeration Date | 2022-05-10 |
| Last Update Date | 2026-07-20 |