| NPI | 1366741746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME128374) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR E-7803) |
| Enumeration Date | 2011-03-24 |
| Last Update Date | 2025-07-17 |