| NPI | 1265731392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 22535) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME T1101) |
| 207Q00000X Family Medicine (Licence: CT 55916) | |
| Enumeration Date | 2011-03-15 |
| Last Update Date | 2025-04-11 |