| NPI | 1194215756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME150148) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PR 33440-R) |
| Enumeration Date | 2018-05-18 |
| Last Update Date | 2025-08-28 |