| NPI | 1093150260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 1014309) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NH 20988) |
| 207Q00000X Family Medicine (Licence: ME DO2872) | |
| Enumeration Date | 2013-05-01 |
| Last Update Date | 2026-06-23 |