| NPI | 1184039448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME139170) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA Mt207399) |
| 207Q00000X Family Medicine (Licence: WA MD60749667) | |
| Enumeration Date | 2014-06-25 |
| Last Update Date | 2026-07-21 |