| NPI | 1215513262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2025-03052) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 100149) |
| 207Q00000X Family Medicine (Licence: FL ME163815) | |
| Enumeration Date | 2021-03-21 |
| Last Update Date | 2025-09-26 |