| NPI | 1225659154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME170839) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2023-00163) |
| Enumeration Date | 2020-05-01 |
| Last Update Date | 2025-01-24 |