| NPI | 1073697025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101236109) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME151069) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2025-02-16 |