| NPI | 1356313696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA MD-49755) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 054765) |
| 207Q00000X Family Medicine (Licence: FL ME-137572) | |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2025-11-06 |