| NPI | 1174208458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 1025714) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101283441) |
| 207Q00000X Family Medicine (Licence: VA 0116037915) | |
| Enumeration Date | 2023-06-15 |
| Last Update Date | 2026-06-15 |