| NPI | 1134433857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ND 12665) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME158614) |
| Enumeration Date | 2010-08-05 |
| Last Update Date | 2026-06-01 |