| NPI | 1346820867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP61683778) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME DO3821) |
| Enumeration Date | 2021-04-09 |
| Last Update Date | 2025-09-22 |