| NPI | 1295183747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301109767) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME172235) |
| Enumeration Date | 2016-05-25 |
| Last Update Date | 2025-03-29 |